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Confronting The Affordability Gap In Health Care Bills

As congressional Democrats work feverishly to bridge the gaps between the House and Senate health care overhaul bills, one issue is becoming a subject of considerable debate: affordability.

More specifically, consumer advocates, along with some House Democrats, are asking whether the average family will be able to afford the health insurance the new law would require them to have.

Ron Pollack, who runs the consumer group Families USA, says he thinks the affordability of the newly mandated insurance will determine whether the entire health overhaul effort is a public relations success or failure.

"I think the way the American public is going to view health reform is on a personal pocketbook test," Pollack says. "If they feel that coverage is affordable, that care is affordable, then they're really going to be very happy with health reform."

"As Charlie Rangel, the chairman of Ways and Means, said, 'If they can't buy it, we can't sell it,' " Schakowsky says. "There are no words, there are no messages, that will cover up for that. And so we absolutely have to — it's an imperative to — adjust the affordability issues."

Schakowsky says "adjust" because there's a big difference between how affordable insurance would be in the House bill compared with the Senate bill. The House bill has much larger subsidies to help people who earn under 2.5 times the poverty line — about $55,000 a year for a family of four — buy insurance.

Several religious and anti-poverty groups highlighted those differences at a meeting last week in a crowded hearing room on Capitol Hill.

"What they decide could mean the difference between a family with a sick child paying $5,000 a year for health care or $1,800 per year," Gloria Cooper of the San Diego Organizing Project told the crowd, describing the difference between what might happen under the Senate bill, which is the higher number, and the House version. "Let me tell you, to a family that is struggling to get by, the difference really means a difference."

Among the people telling stories about being unable to afford care at the summit was a member of Congress — Rep. Donna Edwards. The Maryland Democrat described how, 17 years ago, she was a young mother without health insurance when she slipped and fell in the produce section of the grocery store. She was taken by ambulance to the local hospital.

"They didn't say, 'Do you have health care insurance?' They didn't say, 'Where's your card?' They treated me," she recalled. "And it cost me thousands of dollars, nearly bankrupt me, put me in debt, just like millions of Americans across this country. Affordability is accessibility."

House members have been agitating for the Senate to adopt their more generous subsidy structure. They say that's more important than ever because the final bill is almost certain to drop the House-passed government-sponsored public option. That was supposed to be one way to put pressure on insurance companies to keep premiums low.

But Pollack of Families USA says that unlike some other differences between the bills, getting the Senate to do something about the affordability issue probably won't be all that difficult.

"There's no question that the House leadership wants to make this a top priority and have the Senate move closer to the House provisions," Pollack says. "But I have to tell you, I think that the leaders in the Senate, they too want to improve affordability. And the White House wants to see this improved. So, I believe from all three key sources — the House, the Senate, the White House — this is going to be a top priority."

Of course, making the bill more generous for those with moderate incomes will boost the measure's bottom-line cost. And that means negotiators will have to raise that money somewhere else, which could set off a whole round of other complications.